| NPI | 1134262058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5534) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VI 1255) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-08 |